Provider Demographics
NPI:1760603716
Name:BAKER, JANIS J (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 ROYAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744
Mailing Address - Country:US
Mailing Address - Phone:606-877-9959
Mailing Address - Fax:606-864-2931
Practice Address - Street 1:351 ROYAL DRIVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744
Practice Address - Country:US
Practice Address - Phone:606-877-9959
Practice Address - Fax:606-864-2931
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist